WARNING: Surgery Porn

When it comes down to it, all you really have is your health. And your money. And a flash car. And your own inflated sense of self-worth. But, mostly your health. So when you spend 18 months on a waiting list for something to be done, you’re entitled to get a little grumpy.

My 18 months of waiting finally ended this week when I was given a strange phone call and summoned to Auckland. Not wanting to look a gift shop in the mouth I duly boarded a plane and set out on a wee adventure. And what an adventure it was… it went a little like this.

It turns out that the cardiology unit at Auckland hospital is in the new building, which had this freaking massive 7-storey atrium in the middle of it. Now some might consider that a waste of space. Space that could be used for beds or kitchens or something. But when you’re couped up in a room with two octogenarians for two days, that bit of the hospital that’s almost like you’re going outside when you’re being wheeled back and forth from x-rays and surgery is most welcome.

I’ll be honest and say that I consider myself somewhat of a planner. A planner who knows exactly how bad Wellington hospital really is. REALLY bad. So I didn’t trust them to send anything like the correct amount or type of info to the people in Auckland. At one point it took them a month to get a record from one side of the hospital to the other, and back. A month! So seeing that on the first day on the ward I was free to stay in my trousers and wander about a bit, me and the ‘support person’ (also flown up to Auckland by the DHB) wandered out into Grafton and had lunch. A strong coffee that really, really got the heart racing. We then wandered back to the hospital and asked for me to be given an ECG. This will become important later.

I had checked in at about 10 on Sunday, and they ran a few tests, with the operation due on Monday, “some time in the afternoon”. Boring. Very boring. I’ll skip to the good bits.

I’m given a razor and told to shave my own groin, which I do. It is now intensely itchy.

Later in the day (Monday) a guy in an official-looking coat pops in and spends 45 minutes explaining to me the many ways this could go wrong, and the several ways it could kill me. He then requests I sign a waiver, and leaves. I’m not feeling altogether reassured, but never mind.

Later again, and some nurses in surgical gear turn up and wheel my trolley past the atrium and over towards surgery. Very calming. If I had simply been wheeled down acres of corridors with fluorescent lighting I’d likely be having some kind of David Lynch-induced anxiety attack. But the sight of palms and ferns is, well, peaceful.

I’m wheeled into a big theatre full of machines, TVs, and surgical-looking stuff. They move me off my bed, and onto a narrow table. They restrain my arms, and shift the covers off my groin before covering the main strip down the centre with a heavy, bunched cloth. I naturally thought this was there to preserve my dignity. Turns out that it was there so the surgeon could rest his hands on something while he punctured freaking great holes in my crotch.

You still with me? (Warning: this is a looong post)

Ok. The story is this. For 18 months I’ve been experiencing tachycardia. Basically my heart rate climbs very high almost instantly, for no apparent reason. I could happen any time. When I’m exercising, when I’m eating dinner, when I’m watching a movie. I was on drugs, but they didn’t adequately control it, so I became eligible for what they call ‘catheter ablation‘. My heart is otherwise fine, no cholesterol, no too-much-salt, no hypertension, nothing. Just an annoying inherited condition. And they thought they could fix it.

So there I am, lying on a surgical table with my jim-jams whipped down to my knees. The nurses have coated big sections of my crotch with alcohol and then iodine, and covered my tackle with layers of different sheeting. The top layer is what looks like a green tarpaulin with two holes in it, one either side of my oldfeller.

The surgeon then begins to explain what he thinks is wrong with me, a problem called ‘atrial flutter’. He’s based this probability on some material he’s gotten from Wellington. I chose to ask him to check the material again because there is a more recent ECG. He refers to the one I skillfully had arranged from the day before, and he exclaims, “Garden variety AVNRT! We can fix this easily!” That strong coffee the day before has paid off, big time.

They give me local anaesthetic, and stick me with one of these bad boys, right in that fleshy, creased part of the hip between the lower abdomen and my uppermost thigh. The surgeon is a bit short of time, so he hasn’t waited for the local to completely kick in. The local was sore enough, so that horse-needle makes me gasp.

The procedure is this. You have two types of “veins”. One is your arteries. These carry oxygen to the body. The other is your veins, these carry your blood from the body back to your heart. The surgeons aimed for the veins in my legs (the external iliac vein in the above diagram), puncturing them with the horse-needles. They then insert long wires into the opened veins, and run them up from my groin and into my heart.

You still with me?

Here’s the rub. All this is captured on x-ray. Basically the table I’m lying on is there to capture x-rays, and transmit them to a couple of TVs above the surgeon. That way he knows exactly where the half-dozen wires (and consequent half-dozen holes) are at any given time. So not only am I being punctured multiple times, I’m also being exposed to low doses of radiation. By this stage I’m thinking that this procedure better work.

As you’d expect in an adventure, things start to go wrong as soon as the first wire is inserted. The surgeon is working from my right groin, and trying to run a guide wire up into the top chamber of my heart (the atrium). But it doesn’t appear to be travelling right. The wire should be moving directly up the vein on the left-hand side of my spine (we can see it on the x-ray TV), but it’s moving up the right. Puzzled, he tries from the left side of the groin. Same result. Confused, he consults another surgeon. They chat.

Let me remind you that I’m awake during this entire procedure. They opt for non-general anaesthetic these days. So I’m getting the low-down during the ensuing discussion, and excitement. Both the surgeons are confused, and are asking if the wire hasn’t accidentally gone up some kind of incorrect pathway. They decide it hasn’t, and the main guy has another bash. The wire ends up getting past a blockage of some kind they can’t work out, and sitting next to the heart.

It’s at this point that I’m becoming nervous. One of the risks explained to me earlier in the day was that a wire could puncture the heart causing bleeding. If it was bad enough, blood would flood the protective sac around the heart and I’d be at risk of death without immediate surgery. This would involve cutting my chest open. And right now he’s really giving that wire a good poke around.

You still with me?

They decide that something is odd, so opt to inject some radioactive dye through one of the catheters in my crotch. They manage to capture the flow of dye entering the puncture, travelling up the right hand side, and into the heart. On film it looks like a Canna Lily being highlighted next to the x-ray of my spine. They have to do it twice, because they miss the top bit when they’re tracking the camera north and south along my spine.

The second doze makes my arse tingle weirdly, and warmly, radiating out to my hips. My eyes must be popping because the nurse asks if I’m OK. I opt not to explain.

My vein, indeed, runs along the wrong side of my spine. This makes the main guy so excited he starts to jump up and down, and immediately orders that every heart surgeon in the building is summoned to “check this guy out”. There’s a wait while another couple of guys turn up, during which time the main guy sticks a bunch more wires into me through the multiple punctures in my crotch. The fun has only just begun, it seems.

What transpires is that I have my liver on the wrong side of my abdomen. This means the main vein to the heart is also on the wrong side. In short, I am a little different. But we already knew that, right? The problem this causes is that the vein enters the heart at an acute angle, and can’t be easily accessed with the wires. The gaggle of surgeons converse for a little longer, I’ve already been on the table for 2 hours now, before deciding they have to access the heart from another direction.

This involves two options, which they discuss about a foot away from me. The first is going in through a vein that runs under the collar-bone. The second is the jugular vein. You can guess which I’m holding out for. Out come the needles again. They stick me with incredibly sharp local anaesthetic again, then grind past my collar-bone with the horse-needles.

And for the last time, you STILL with me?

Once all the wires are in it becomes a doddle. The heart works on electrical currents. They start at the top of the heart, and wash like a wave over the heart pushing blood out into the body. The wires are able to do two things, measure the amount of electricity at any given point, but also to stimulate the heart to find out where in the hell all the problems are. As it turns out, I inherited some kind of “short-circuit” that cause the heart to kick into overdrive unnecessarily. There’s a part of the heart that prevents this (the AV node), but the “short-circuit” undermines it .

Eventually, once a number of tests have been run, it is established that this “short-circuit” has to be burned out with a burst from a specialised wire. The tests involve stimulating the heart to speed up, slow down, jump about, and generally freak out like a teen on too much ecstasy.

They’re able to isolate what is preventing the AV node from doing its job, and they nail that bastard with a burst of something like a laser. Christ it hurt. Essentially they’re frying a small portion of one of my organs, without anaesthetic, and I get to watch it on “X-Ray TV”.

But! That’s it! Procedure finished. They run a half-hour of various tests, and it seems to have worked. I now have a mere 5% chance of re-occurance, and they begin to break down the theatre! This involves the surgeon phoning up his mates to tell them about “the guys reversed liver”, a bunch of people whipping the huge catheters out, then four nurses taking all the garments off and cleaning my groin with with sponges.

You know, TV would make that look erotic? Four nurses crowded around a high table, staring at your oldfeller and gently dabbing it with clean water.

It’s not.

Finally they send me back to the ward. I’m covered in something like a dozen punctures from the various attempts to get all the wires in. I’m knackered from four hours of various drugs, chemicals and slight blood loss. And I haven’t eaten since 6am. It’s now 5.30pm. I’m not allowed to sit up so my support person has to hand-feed me. I’m thinking I’ll develop deep bruises in three places (which I have in two)

But, I haven’t had an episode since! I now wait till Friday to make sure the burns have healed correctly (if they haven’t then I have the op again, with a lessened chance of success. Should be OK though).

I’m waiting till the next week to get back into fitness, then you know what? I’m going out snorkelling for paua, just like the old days.

But first, come Saturday morning, a short expresso, just the way I like it.

Thanks a lot for relating such a delightful story. My experience with the hospital system makes me question everything so I am fully informed with what is going on. One must take firm control of one’s own treatment, and not blindly accept what the officials do to you.

It must be nice to know your liver shares your political leanings. For a moment there I thought you were going to be one of those people whose insides are completely reversed.

I have to say, of the whole tale, the bit that disturbed me most was where you’re on the operating table, telling your surgeon to have a look at your latest scan, so he can go “oh, right, I should be doing this other procedure”.

hmmm… questions in order. dunno how much radiation i got. but, meh. the grandfather was in the clean-up operation at hiroshima, and he lived. if i can inherit his physiology i can inherit the good bits too.

the support person was the woman with whom i live. you’ll doubtless understand it from there. no, she wasn’t inherited. and i was running out of words for ‘me bits’.

and no mental condition developed. that i’m aware of. compared to the 18 months of hassle since the tachycardia kicked in, the two days in the hospital was a doddle!

Questions:
– What was your ‘support person’? Was this a family member, a mate, someone useful from the DHB?
– Is it hereditary?
– Why do you call your penis ‘oldfeller’, was it grafted in an earlier op from someone older than yourself?

And one for Jo
– “lady parts” … ? (I know what they are, just why the name 😉

And now I’m being silly.

Thanks for posting it – quite some adventure and I’m glad to see you’re back in your Hobbiton all well and good.